Compass: Emergency Medical Technician Shortage

– [Voiceover] The
following program is a production of Pioneer
Public Television. (light music) – Hello and welcome to Compass, a new production from
Pioneer Public Television. I’m Less Hein, your
host for Compass and this is a weekly
discussion of public policy and important issues
facing our viewing area. This week we will discuss
what kind of challenges rural emergency response
teams are facing when it comes to getting and
keeping their volunteers. We’ll also touch
on what’s been done to combat the EMT
and EMS shortages across Minnesota with
training and education through local
awareness and outreach. First, we have the story
about a partnership. Stevens County
Ambulance has created with the University
of Minnesota Morris to educate and train
premed students as volunteer emergency medical technicians for their area. Here is a report from
Pioneer’s Laura K. Prosser. – [Voiceover] With
many rural towns struggling to find
volunteer EMTs, Stevens County Ambulance is
one of the few exceptions. Thanks in part to
an old partnership with local colleges and high
schools in their county. – The partnership
actually started back in the 1980s I think,
is probably where you can pinpoint it to with the
University of Minnesota Morris. We had an opportunity to
give pre-hospital experience to students that were
going to medical school. So it was hands-on, it was
patient care experience in the ambulance,
and it gave them really an edge up when
they went to medical school and started learning the skills that they had already practiced
in the pre-hospital setting. So we developed the
program, the EMT class, and were also given an
opportunity to offer college credits through
UMM for the course. So we did that for several years and as we developed the
education programs further we also saw an opportunity to provide this training
in the high school and so we partnered with Morris area high school,
the school district. – Through the University
and the high school class that we offer you’re
looking at 180 to 200 hours worth of classroom
time and then time away from the classroom. The time away from the
classroom is they can have anywhere from 2 to 3
chapters to read after each night of class. In the classroom,
there’s lecture. We try to hope the
lecture to a couple hours and so we end up
having a couple hours for the hands-on part of it. – [Voiceover] Begin. Look carefully… – Once we get to kind
of the characteristics of an EMT and the
job responsibilities and wellness of the EMT,
then we start getting into the anatomy and physiology. After that then you
start talking about CPR and patient assessment. That’s when the skills
start coming in. Throughout the class
there are some quizzes they have to take and there
are some section tests that they have to take. But then as they get
towards the end of the class we start prepping them
for the National Registry examination process
which is a practical exam and a cognitive exam where they have to do an online exam. And we do that by
setting up stations. There’s four random skills
that they have to know. And they have to
perform one of those at the National
Registry Practical Exam. So they need to know all four. So they’re practicing them constantly throughout the class. – [Voiceover] For
Stevens County EMS it’s not just
about the retention or shortage of volunteers. It’s about addressing
a bigger issue. The issue of spreading EMS
awareness and education. – Retention for us here at
Stevens County Ambulance Service out of the University
program, out of a class of maybe 15 to 20 students
we’ll probably get 3 to 5, 6 of them
apply to work here in the ambulance service. – And so, when you start
fostering that interest in pre-hospital care or just
the medical field in general when these kids are young
than they might go off to medical school or
go live in the big city for a little while but
then they might reach back and say, you know what
that made a lot of sense. I’m going to move
back to the rural area or perhaps I’m gonna
stay in the rural area and continue my education. And when we can deliver
programs remotely out here in the rural areas
it makes that prospect a little bit more likely. When you look at
recruitment and retention and really just the shortage of qualified personnel
in the rural areas. You have to look at the
way you’ve traditionally done things and you gotta say, okay, how do we
do it differently? How do we expose people to
all of the opportunities that are out there through
the opportunity that we have to educate people
and work with people in our EMS education programs? – That’s one of
the biggest reasons I think we started the
high school programs, was to help people
become more aware, or these kids to
become more aware that there’s a whole
array of different jobs that they can have. I have one guy that worked
here on the ambulance service that went through
our EMT program. He said when he
went to med school, “I got into classroom
and we started talking about blood pressure
cuffs and stethoscopes, and half the class didn’t
even know what they were.” He says, “I knew what they were, I knew what they could tell me, what’s wrong with my patient, and how to use the thing.” So he said, I felt
like, the medical school was a whole lot easier for him just because of the
experience he’s had here. And so I think where the
university really likes to partner with us is
that they have 60 to 80% somewhere of retention
where they’ve gone on to become paramedics,
flight medics, LPNs, RNs, x-ray technicians, doctors. – [Voiceover] When it
comes to the Stevens County Ambulance
program, it’s all about teaching a service. Initially, teaching a
service for retention or recruitment but
the service has turned into a more regional application of teaching communities
to save lives. – Even if we don’t
recruit an EMT from one of our classes
maybe we recruited somebody or trained
somebody rather that’s going to go on and work as an accountant,
or lawyer, or in a trade profession that now
has learned the skills and gained the confidence
to respond to an emergency. And even through that,
maybe they can save a life or have an impact
on somebody’s life because they had the
confidence to grab that AED off the
wall or start CPR. Even the ability to
interact with somebody into a patient
assessment or talk with somebody to
figure out what, what’s bothering them, right? Because that’s what we do
as EMTs and paramedics. We can transfer
some of those skills and teach people
some of those skills and give them the
confidence to use those skills and
interact with people. Maybe that’s part of
why we’re here as well. And maybe through
that we can start to address this issue
of shortage of EMTs and paramedics in
our rural areas. (light music) – And with us now to talk about building quality local
teams and improving their volunteer base is Randy Fisher of Ringdalh EMS. That’s the collaboration
of four advanced services and groups in
Minnesota/North Dakota. And we also have
with this Dan Speaker from the Raymond Ambulance. So gentlemen, thanks
for being with us. You know Randy, I’d
like to start with you. Tell us a little
bit about your area. Because we have
viewers scattered over such a wide area; tell us a little bit more specifically what area you serve. – Sure. Ringdahl, my position
with Ringdahl EMS, we have operations in both
North Dakota and Minnesota. In North Dakota, it’s Jamestown,
Castleton, and Lisbon. And also in Minnesota
we have Fergus Falls and Pelican Rapids. I also oversee and operate
Stevens County Ambulance in Morris, Minnesota. – So quite a large area? – Yeah, we have a lot
of volunteer, rural services; every one of ours. – Yeah, okay. And Dan in your
case, Dan Speaker, Raymond, just south
of Wilmer, Minnesota. You got the community of Raymond and surrounding townships
and that right there. – Yeah, we cover
Raymond and part of the rural areas of Pennock,
Bloomkest, Princeberg. We also cover Claire
City Ambulance if they’re out on a call. We’re actually the backup
service for Wilmer Ambulance if all four of theirs are out. – [Voiceover] Sure. – We’ve actually got over to
Maynard too for some calls. – Quite a large area than. If people aren’t familiar,
from Wilmer to Maynard that’s almost 30 miles there. So that’s also a fairly… – Were right on the
border of Kandiyohi County and Chippewa so we do a
lot with both counties even though we’re
in Kandiyohi County. We do cover Chippewa. – Sure. So what happens is
both of you are dealing with heavily rural areas. Wilmer being a town of
19,000 and Fergus Falls being a good size town. But largely, you know,
predominantly rural areas. What are the biggest
challenges that you face in what you do? Randy I’ll start with you. – Staffing. Staffing is a critical
shortage right now. It’s not only in our
rural areas in Minnesota. But as we we were talking
earlier, North Dakota also. And quite frankly,
throughout the United States. Finding EMT’s and paramedics,
sustaining ambulance services in rural
communities is a challenge. A challenge that’s been
growing for a long time and we need to address
it in some new ways. Because people are
finding it difficult to volunteer for a
local ambulance service. And quite frankly, I’m not sure that that is the model
that is sustainable or the model that we as a public demand from our communities. Because it’s becoming
such a organization that needs to be able to respond with high-quality,
well-trained people on a regular basis,
not just on whether or not they’re available or not. We require, when 911 is called that they respond. – I know one of the things
that came up a little earlier, Dan we were talking you
know just before the show, before we started recording
it we were talking about in your case, you notice
in this town, in these towns you serve used to be
had a lot more businesses, you had a lot more people
working in businesses and so the environment
was different. That’s where a lot
of the volunteers to come from, right? – Yeah, a lot of
the store owners it would be them, somebody
they hired, or a spouse. A lot of times they
would, beyond, you know, ambulance or fire, and
if there was a call they would drop
what they’re doing and respond so we’ve
always had a good response. And as businesses seem to
disappear from the small towns you lose a lot of the
people who are working in the small towns. You’ve got to try to find a
new source of people to help. – Right, and a part of this
is also that if you look at new people to help is
a critical one because you may have people who have
enjoyed it and it’s been a big part of their life
serving on an ambulance crew. But a number will reach a point
where, whether it’s patient care or lifting people into
an ambulance they’re just not physically capable
to do it anymore, even if they want to. I suppose we’re seeing some
of that too, as well right? – Well, absolutely. We have a growing population. We have more volume
of runs that typically that are services
are responding to. We have increased
number of hours for training for a volunteer
or a paid personnel. And, it requires a
lot of your time. When we talk about a full
time position, or full time volunteering for a
volunteer they’re sometimes doing 2-4,000, maybe
6,000 hours in a year. You, when you were there, we
were talking earlier, you said you were the only one
responding in many cases. – In 2013 is when we
had our big shortage. – And somebody’s gotta
cover it because when a 911 call comes in, someone’s gotta
respond in our rural areas. – Is that one of things
you’re running across is that people will sometime take
this for granted because they rely on emergency services
and they assume there there? Do you think a lot of people
in communities you serve actually understand what’s
happened with this shortage and how it’s gotten worse? You know, I think
some communities yes, and some communities
believe that we still can run it with volunteers. I’m not confident that
that’s possible anymore. There’s so many demands on
families’ times and it’s difficult to drop everything
that you’re doing to go out and respond on a volunteer
organization. It’s not just ambulance. It’s fire departments that have
volunteer fire departments. It’s every one of our community
service organizations that are seeing declines
in volunteers that are volunteering for
their organization. I don’t think it’s just EMS,
but it hits EMS in a critical state because when we
dial 911 we expect, and we want someone to respond. Somebody well trained. Somebody capable of taking
care of a heart attack or a trauma
situation or a stroke or whatever the
medical emergency is. – Well I expect working patterns
also change because I know Dan we talked about small
town businesses for example. Now in many of these
communities as many of them as transitioned over time to being more like bedroom communities. Well these are people who may
leave the house at seven and not back in that town
until seven at night. So even if some of them wanted
to serve there’d be a big chunk of time where they
wouldn’t be available, right? – Definitely, Castleton is a
good example is not too far away from Fargo/Moorhead area. And many people move or go
to Moorhead or Fargo to work and we have a struggle
with daytime coverage. Some of our services, most of
our services have transitioned into a combination of
paid and volunteers. That is helping, but you
can’t sustain that either if you don’t have funding. Or if you reimbursement
mechanisms don’t
change to help pay for that part that the
volunteers were contributing, or have been contributing
over the past 40 years while EMS has been growing. If we don’t have funds that
replace those volunteers that were doing it for
free or literally for free. Maybe $1 or $2 an hour,
but basically for free. If we don’t have some funds
that replace that to help sustain it I’m not sure how
we’re going to sustain it. – Ours is becoming one of
those bedroom communities. We have a lot of people
that are coming in and buying a house and then
renting it out to people. So I think that is part of the lack of a better
word, a problem. So people are coming in
renting, they’re not putting down their roots, so
they don’t really wanna volunteer for
something like that. They’re there for six
months, a couple years, and then they’re gone
to another community. – Sure. And then when you look at
the training; I know earlier you had mentioned there are
some significant training requirements and some of those have increased over the years. If someone wants to get
involved as a volunteer, what are we talking about
in terms of volunteer hours just involved in training alone. How much time does that take? – Well when I first got
involved in EMS to become and Emergency Medical
Technician certified, it took 81 hours. That’s what it was back
in the days I got started. I’ve been doing this for
40 years now, in EMS. Now, the class is about
160 hours minimally, to become certified as an
Emergency Medical Technician. Which is the minimum
requirement to work on a licensed ambulance service
in the state of Minnesota. There are variances
that have been proposed and I believe are in
place right now for Emergency Medical Responders
or what used to be termed First Responders
that can operate as one of the individuals
in that ambulance. So that offers some ability
to decrease the amount of training that’s required. Quite frankly, it’s doubled
in the amount of hours and then it’s ongoing
sustaining hours to retrain and stay
skilled at our profession. – Well one of the things that
I’ve picked up from volunteers I’ve talked to over
the years is burnout. Because the number of
volunteers they can call on has decreased, more has been called
upon by them individually in some cases, so they may
have had a commitment for part of the time but now as that
commitment grows aren’t we seeing some people
burnout on what this is? – Well that’s basically is
what happened to Raymond. I used to be on the City
Council and I worked in Wilmar. We had three EMT’s and they
started complaining that they were doing most
of the calls and were starting to get burned out. At that time, we tried a couple
things to get other EMT’s or other people to
volunteer and take the training to become EMT’s. And nothing seemed
to be working. Then shortly after that our
city maintenance worker had quit and so I came up with
the idea, I said to the other council member, “Well
since I got the EMT class, should we see how we
do as the city guy?” You know, I had to pass all
the requirements for the city. Our current mayor, who was
on the council at that time when I started, he said,
“If there’s a call, unless it’s something necessity, you drop what your doing and go on the ambulance call.” So we’ve had good
support from our council to respond for the ambulance. Since I started working for
the city those three people have basically just had
the burnout and have quit. So that’s taken a lot
of the help we had. – So what happens? There have been these cases
where you may have these two, three, and four person
crews in rural areas and then suddenly two or three of them, like if was a husband
and wife team, I know there are those scenarios. They say, you know, we’ve
been doing this a long time and we just can’t
do this anymore. If those two quit and
you got two others, that’s not enough time
for them to continue, what happens in
some of these areas? Are there examples of that? And what does the community do? – Well for us, as I was talking
a bit before about 2013, I think it was. We’ve had basically a lot
of people, they either get jobs out of
town or they quit, and it ended up being me. We had a couple calls that
were called in as non-emergency calls and basically
I just grabbed a
fireman and said drive. I went out to the
non-emergencies
and we had voiced our concerns with our Field Rep. They said they understand
that we were having problems, and as it’s a continual
thing they’ll overlook. The requirements
back then was you had to have two EMT’s to transport. – Okay. – And since we were doing
it with a non-emergency they let us slide for a little bit. And they informed us of
this program that they call, A Hardship Variance,
which basically lets you with what was called the
first responder have them drive and the EMT would
make your service legal. Now I believe the
state has reclassified them as Emergency
Medical Responders. But, we had to get people
who were willing to take that and that was a lot
shorter training. I think that was 40 hours. – So a lower level of training
and a lower delineation of title, so to speak. – So I think it was about
four of them to do that. – So that’s one
possible solution there. You can change some
of the training. I’d like us to also talk
about, before I forget, where we go because we
talked about some solutions. The volunteer piece as well, maybe that’s not
working so well. But is the paid
part sustainable? So where do we go? Maybe this is too
much of a wish list, but where do we go in
Emergency Services> Where do we go next? – Well I think the partnerships
with the cities, making sure the businesses
locally attempt to allow employees to maybe
volunteer or to work on ambulance services in our
rural areas is very important. Those partnerships need to be nurtured and
somehow expanded. Funding is another thing. We need to more adequately
fund it so that we can maybe pay better those
people to leave their jobs or pay better those people
to be able to volunteer on a longer term basis. And we also just have to
continue to grow our own people. You find people in a community
that have this interest and have this passion in serving
their community in some way, and will take the training, We need to maybe help
fund their training. We do that in Ortonville. There’s a foundation at
the Ortonville Hospital that supports the
local people if they want to take an EMT class. Fantastic effort. It brings some people in. But we still have
shortages there. Some people finish the
class and maybe don’t want to volunteer, or
can’t volunteer, or don’t have the
time to volunteer. So we still have
those challenges. In Morris for example, we utilize a high
school based program. We’ve got an 86% retention
rate in a program there, that Stevens County
Ambulance does. They work with the college. There’s all kinds of
different ways I think that we can try and engage local
community professionals and people to maybe
do this as a side job, or as a part time job, or
community service that they do. But it also still demands
well-trained, competent individuals to take care
of you when you have a heart attack or me
when I have a car crash or anyone when they dial 911. – So we’ve got a couple minutes
left here but it strikes me when someone’s watching this
program and as you said they haven’t put down roots or maybe
they have another problem. But I know some people who
may have an interest in this. So if someone wants
to become engaged and wants to learn about
this, how do they start? How do they start by
learning where to go? – From us, they usually get
a hold of the EMT leader. I’ll constantly talk to
people, “Would you want to join or volunteer to
help here or there.” As I said before the council has always been very supportive. Our council will
pay for the class. They just require that
the person stay on for two years afterwards. – You’ve seen that a lot in
communities, there’s that sort of council support, because
they realize its important. So they’re paying
for more training necessarily than
they used to, right? – I think so, in some cases. If there’s people out there
that are interested in working on an ambulance
service, I think the first step would be go contact your
local ambulance service. Talk to them about what
opportunities are available, where they have the
training, how they can get involved in the training and
go out and become trained. Because the first
step regardless of
whether or not you’re going to volunteer on a
local ambulance service or rescue squad or first responder
team or fire department is to obtain the training. And that training isn’t just
gonna benefit your local ambulance service and
your fire department. It’s gonna benefit you
as an individual at your place of work, in your
community, if you’re working with the boy scouts or any
kind of civic organization. That training, if you stop
on the side of the highway to help somebody that’s injured
is going to be beneficial. So take the training. – Randy, Dan thank you both. We’re out of time. Appreciate you coming in talk to us about Emergency Services. That’s it for this
week on Compass. Join us next week as we
take a look at the future of higher education as it
pertain to liberal arts, private colleges in our viewing area. Thank You. (music)

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